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Saving Sepsis Patients Protocol & Practice
Rebecca Sell, MD
UC San Diego Health Systems
Overview
•About UC San Diego •Protocol & Process •Dashboards •UC System-wide Collaborative
UC San Diego Health Systems
• 2 campuses • Hillcrest (357 beds) • Thornton/SCVC (173 beds)
• Quaternary care • “County hospital” • Training program
• Medical students • 775 intern, resident and fellow trainees • Additional 100+ trainees in non-ACGME
accredited fellowships
Process prior to SEP-1
• ED only
• Code sepsis activated on triage by RN
• Aggressive fluids, cultures and lactate, and broad-spectrum antibiotics
• Multiple nurse champions
• Each case individually reviewed by Critical Care MD with feedback for missed cases, missed opportunities as well as successful cases
SEP-1 MULTI-DISCIPLINARY COMMITTEE
CMO/CNO Infectious Diseases MD
Coding specialists Performance Improvement and Patient
Safety analysts
EMERGENCY ROOM ED MDs
CNS ED RN champions
Pharmacists Information Technology
1. Improve recognition of Severe Sepsis & Septic Shock
• Nursing education
• Physician education
Screensavers
Handouts, posters, slideshows
2. Create systems to make compliance easy • Simplified ED and inpatient specific order-sets
• Changed the definition of abnormal lactate to comply with SEP-1
• Automated repeat lactates
• Emergency standing orders for rapid response RNs
• Automatic reminders for physician reassessment
• “dot-phrases” to ensure exam/documentation complies with SEP-1
Order-set:
Nursing flowsheets
Improving documentation of reassessment
3. Simplify process
• Build on established systems • Inpatient RRT response • Code Sepsis in ED
UCSD and Rapid Response
Roles & Responsibilities
Checklists
Dashboards and reporting
• Collect data
• Analyze data
• Reports
Comparisons reported quarterly
• Hospital
• Wards/unit
• UC wide
• UHC/Vizient
UC Wide Collaborative
• Weekly phone calls for PIPS team
• Every other week for physician champions
• Shared comparison data